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REHABILITATION FROM HEART DISEASE: CAN I PREVENT MY CAD FROM RECURRING OR PROGRESSING?
Cardiac rehabilitation usually focuses on the major risk factors for coronary artery disease. These include elevated cholesterol, smoking, high blood pressure, diabetes, obesity, physical inactivity and perhaps certain personality profiles. A family history of coronary heart disease, especially in close relatives who were diagnosed with heart disease before age sixty-five, indicates that you are at increased risk of developing coronary disease yourself?but of course this particular risk cannot be modified. Recent theories, yet to be proven, suggest that hardening of the arteries may have as a contributing factor inflammation of the artery wall indirectly caused by a chronic infection potentially treatable with antibiotics. In addition, higher amounts than normal of a substance called homocysteine in the blood can increase the risk of heart attacks. This factor may be important since it can be mitigated with a vitamin-like food constituent called folic acid.
It must be emphasized that, for most patients, no single or combination of risk factors is known to be the cause of heart disease. Many people in fact have no risk factors for coronary artery disease, and thus may legitimately ask, “Why me?”, having perceived themselves as having done “nothing wrong.” Although statistics tell us that risk factors, especially combinations of risk factors, do indeed increase the likelihood that someone will develop hardening of the arteries, our ability to predict in given individuals how likely they are to develop heart disease or a worsening of heart disease is not very good. Rehabilitation therefore must focus on a general approach to diminishing all possible risk factors.
A great deal has been written about proper nutrition, particular exercise programs and stopping smoking. No one particular diet, exercise program or approach to stopping smoking is right for all individuals. Every person has his or her own unique profile of circumstances, needs and opportunities to which a particular rehabilitation program needs to be adapted. The best programs will thus deal with each person as an individual, and tailor a “made-to-measure” program that fits his or her own particular style and possibilities. For example, a program of long-distance walking may not be applicable in communities where the winters are long and where there are no indoor facilities for exercise. A diet emphasizing fresh fruits and vegetables, which is highly desirable, may be inappropriate for individuals with financial difficulties, or in communities where some of these items may be in short supply in the winter. As we emphasized above, perhaps the most important aspect of rehabilitation is assisting the patient to come to terms with the need for self-assessment and need to choose a positive, optimistic road toward improved well-being. Beginning the rehabilitation program with calm, contemplative decision making is essential if the program is to succeed and be maintained in the long run.
Patients often ask, “How do I stop smoking?” or “How do I begin an exercise program?” We always answer: “First you have to want to do it.” In other words, you have to make an active decision to break a bad habit or develop a good one of your own free will and with a positive resolve. Once you have taken that step, actually doing what is required is little more than a detail.
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